Tobacco Prevention: Looking Beyond the Statistics 

By Sibyl K. Bowie


Closing the Gap, Oral Health • July 1999


What is the harm in a little pinch of snuff or chewing to­ end of the first year nearly 100 percent of the students had 

bacco a few times of day? According to the National Insti­ received educational material. 

tutes of Health’s National Cancer Institute (NCI), the •	 Literature and posters on the hazards of tobacco usage and secSurgeon General concluded as early as 1986 that the use of smokeless ondhand smoke were placed in strategic locations on the reservatobacco “is not a safe substitute for smoking cigarettes.” tion. Public service announcements were aired on the local radio 

Smokeless tobacco can cause cancer of the throat, larynx, and station. 

esophagus, as well as the lip, tongue, cheeks, gum, and the floor and •	 Various tribal, federal and state government departments, and 

roof of the mouth. Chewing tobacco and snuff can lead to nicotine the local school and community college systems distributed pamaddiction and dependence, and can cause a number of noncancerous phlets and showed tobacco education videos. 

conditions such as high blood pressure, gum disease, loss of bone in •	 The Spitting Image Smokeless Tobacco Teaching Guide was develthe jaw, and tooth decay. oped by the Indian State Board of Health for use as a permanent 

Chewing tobacco and snuff contain 28 cancer-causing agents, part of the middle school curriculum. 

including formaldehyde, used in embalming fluid, polonium, which By 1995, when the BDD added smoking prevention objectives 

gives off radiation, and the highly addictive nicotine. One can of to its program, the percentage of sixth graders who had experimented 

snuff delivers about as much nicotine as 60 cigarettes. with and used smokeless tobacco had decreased, but those who had 

Despite the warnings, smokeless tobacco use was extensive among either tried smoking or were smokers had increased. 

American Indian adolescents on the Blackfeet Reservation in north­ In 1999, data indicated the number of students who tried smokewestern Montana. That is, until the Indian Health Service’s (IHS) less tobacco products decreased by almost 20 percent since the study’s 

Blackfeet Dental Department (BDD) intervened in 1988 to raise inception. The percentage of students who were smokeless tobacco 

awareness about the dangers of smokeless tobacco. “Students as young users remained about the same. However, those who experimented 

as six years old were found purchasing and using smokeless tobacco with smoking or smoked rose between 1989-99. 

products. They would bring tobacco to Head Start to share with their “We may be witnessing an increase in cigarette smoking because 

friends,” according to Julie Rattler, a registered dental hygienist at the it’s easier for young people to access cigarettes since the passage of the 

Browning clinic—one of two BDD clinics operated by the IHS in Tribal resolutions and state laws regulating the sale and possession of 

Montana. “Much of the smokeless tobacco used by the adolescents smokeless tobacco products to and by minors,” Rattler said. There 

was without their parents’ or guardians’ consent.” In January 1988, have been some small victories for the BDD. “We’ve experienced some 

the Blackfeet Tribal frustrations too,” said Rattler. “But we must constantly look at our 

Council was the first in the U.S. to pass a resolution banning the community to see anything positive which helps us to be more optisale of tobacco products to minors and limiting the public utilization mistic.” 

of these products to traditional use. Six months later, the BDD sur­ Ten years ago, according to Rattler, teachers were smoking in 

veyed 11-19-year-olds through the Reservation school systems and classrooms with students present. Now, that is never done. In fact, 

found that almost 94 percent used smokeless tobacco products. many have quit smoking. Ten years ago you could go into the Tribal 

The BDD targeted sixth and eleventh graders in the fall of 1988 Offices and the majority of adults, including employees, were smokas a part of a community-wide health education program on the ing or using smokeless tobacco right inside the buildings. Now there 

hazards of smokeless tobacco. Methods used to reach students: are just a few standing outside in the back. “You need to look continu­

•	 As part of Montana’s Tobacco Free by the Year 2000 educational ally at the small improvements for gratification. And, we must conprogram, students are being followed over the course of 12 years tinue to provide the education needed to precipitate change”, Rattler 

and given special tobacco prevention educational material. concluded. 

•	 Presentations were made at all of the Blackfeet Reservation schools For more information on tobacco and cancer, contact the NCI’s 

(grades K-12). Each grade received age-specific information in Cancer Information Service at 1-800-422-6237. You can access NCI’s 

the form of videos, handouts and verbal reinforcements. By the Web site at http://www.nci.nih.gov.

Surgeon General’s Report on Tobacco 

Use Among U.S. Racial and Ethnic Minority Groups, published by the Centers for Disease 

al and 

The 1998 Surgeon General’s Report, Tobacco 

Control and Prevention, indicates that rates of tobacco-related cancers other than lung cancer vary widely among members or raci

larly high among African American men. This is the first report in the 34-year history 

n tobacco use to focus on the impact on African Americans, American Indians and 

ns and Pacific Islanders, and Hispanics. 

wse the CDC’sWeb site at: http:// www.cdc.gov/nccdphp/osh/sgrminorities. htm.

ethnic groups, and are particu

of Surgeon General’s studies o

Alaska Natives, Asian America

To view a copy of the report, bro

Office of Minority Health Resource Center	 U.S. Department of Health and Human Ser